University life is drawing to a close, and we all know that we have to pass the final graduation thesis before graduation. Graduation thesis is an important form of preparation, planning, formalization and testing of university learning achievements. How to write a graduation thesis to attract more attention? The following is my graduation thesis of medical college students. Welcome to read the collection.

abstract:

Mycoplasma pneumoniae (MP) is one of the common pathogens of respiratory tract infection in children, and the infection rate is on the rise in recent years. 10% ~ 30% of community-acquired pneumonia is caused by MP infection, and foreign literature reports 9.6% ~ 66.7%. Mycoplasma pneumoniae pneumonia has different clinical symptoms, which easily leads to multi-system and multi-organ damage and misdiagnosis. This paper analyzes the clinical data of 96 cases of mycoplasma pneumoniae pneumonia in children diagnosed and cured in our department from June 2005 to June 2007, aiming at improving the diagnosis and treatment level of the disease.

1, data and methods

General information 1. 1 96 cases, including 56 males and 40 females, 9 cases from 4 months to 1 year, 3 years old1case, 32 cases from 6 years old, 44 cases over 6 years old, and the incidence before 3 years old accounted for 20. There are 33 cases in summer and autumn, 63 cases in winter and spring, and the peak month is 1 1 ~ 1.

Fever occurred in 72 cases (75%), including low fever 13 cases, moderate fever1case and high fever 18 cases. There were 89 cases of cough (92.7%), wheezing 18 cases (infants 13 cases) and chest pain 19 cases. Headache and dizziness 1 1 case; Chest tightness and fatigue in 9 cases; 6 cases of convulsion. In physical examination, there were 53 cases with coarse breath sounds, 65,438+03 cases with low local breath sounds, 65,438+07 cases with dry mouth rales and 65,438+03 cases with wet rales. Hepatomegaly in 3 cases.

1.3 auxiliary examination: fasting venous blood was collected from all cases, and MPIgM was positive by ELISA immunofluorescence. Peripheral blood WBC < 4.0× 109/L 10 cases, > 10.0× 109/L24 cases, (4.0 ~10.0 )×/kloc-0 cases. 40 cases were determined by ESR, and 25 cases were more than 20 mm/h 2. CRP40 was measured in 40 cases, and > 5 mg/ml 12 cases; Myocardial enzymes: LDH increased 14 cases, CK increased1/kloc-0 cases, CKMB increased 16 cases, and α -hydroxybutyrate dehydrogenase increased 13 cases; EKG showed 56 cases, sinus arrhythmia 65438 03 cases, ventricular premature beats 2 cases and STT changes 5 cases. 6 cases had abnormal EEG.

X-ray examination in 40 cases (465438 0.7%) showed mottled opacity of both lungs. Reticular nodules of both lungs changed in 22 cases (22.9%); Segmental or lobar infiltration was found in 30 cases (365438 0.3%); The hilar shadow is enlarged and thickened 1 1 case (11.5%); 5 cases were complicated with a small amount of pleural effusion.

1.5 Among 96 cases of extrapulmonary complications, 30 cases had extrapulmonary complications, accounting for 3 1.3%. Among them, myocardial damage 16 cases, ranking first in extrapulmonary complications, accounting for 53.3%; Six cases involved the nervous system, showing febrile convulsions and mild to moderate EEG abnormalities; There were 5 cases of urinary system damage, 3 cases of transient urinary protein and 2 cases of transient urinary red blood cell positive. 9 cases involved the digestive system, showing abdominal pain, vomiting and diarrhea; There were 3 cases of skin involvement, showing pleomorphic maculopapules, all of which appeared in the fever period.

1.6 treatment and prognosis azithromycin 10mg/kg, once a day, was the first choice in this group, and it lasted for 5 days, and 3 days after stopping taking the drug was a course of treatment. For mild cases, after one course of treatment, take orally (taking for 3 days and stopping taking for 4 days) 1 ~ 2 courses of treatment. Patients with lobar pneumonia were treated with intravenous drip for 2 courses and oral administration for 2 courses, with a total course of 4 weeks. For children with severe mycoplasma, erythromycin was injected intravenously at 25 ~ 30 mg/kg for 7 ~ 10 days, and then azithromycin was taken for 3 days and stopped for 4 days, with a course of treatment of 2 ~ 3 weeks. In patients with myocardial injury and brain injury, VitC, VitE, coenzyme Q 10, fructose or energy were added to improve the metabolism of myocardial cells and brain cells, and 0. 1 ~ 0.25mg/kg was injected intravenously at an early stage for 3 ~ 5d. Results All cases were cured. After 2 ~ 4 weeks, 76 cases were reexamined, 68 cases were completely absorbed, 8 cases were mostly absorbed, and the clinical symptoms completely disappeared.

Step 2 discuss

At present, MPP has become a common and frequently-occurring disease in pediatrics, which can occur all year round. The peak of this group of cases is from late autumn to winter. The onset age is mostly school-age children, accounting for 47.9%, but infants are not uncommon, accounting for 20.8%, and the youngest is 4 months. The main clinical manifestations of MPP are fever with persistent dry cough, and there are few early pulmonary signs and wheezing in infants. X-ray manifestations are earlier than signs, and there are four main changes: bronchopneumonia is the most common, accounting for 41.7%; Secondly, segmental or lobar infiltration accounted for 31.3%; The reticular nodules of both lungs changed by 22.9%, and the hilar shadows were enlarged and thickened 1 1 case11.5%; A small amount of pleural effusion was found in 5 cases of lateral chest radiography, all of which occurred in children with lobar pneumonia. Such children should pay attention to lateral chest radiography. Laboratory examination showed that 64.8% patients had normal white blood cells, 62.5% patients had elevated erythrocyte sedimentation rate and 30% patients had elevated CRP. All patients in this group were positive for MPIgM, and the titer of MP antibody generally began to increase around 1 week after infection, and reached the peak in 3-4 weeks, lasting for 4-6 months [1]. Therefore, for children with the above clinical manifestations and X-ray features, routine detection of MPIgM should be performed 1 week after onset, so as to make a definite diagnosis at an early stage.

MP can not only cause respiratory tract infection, but also involve skin mucosa, cardiovascular system, nervous system, urinary system, blood system, digestive system and other systems. There were 30 cases of extrapulmonary complications, accounting for 365,438 0.3%. Among them, myocardial damage is the first, which is mostly caused by the increase of myocardial enzymes and/or abnormal ECG. According to our observation, the damage of MP to myocardium is certain. After anti-inflammatory treatment 1 ~ 2 weeks, most symptoms disappeared, ECG returned to normal, and myocardial enzymes returned to normal within 4 weeks. Six children with brain injury developed convulsions and mild or moderate EEG abnormalities. Most of the myocardial damage and brain injury in this group are mild cases. It is generally believed that immune factors play a major role in the pathogenesis of extrapulmonary complications of mycoplasma pneumoniae pneumonia. MP antigen is partially the same as human heart, lung, liver, brain, kidney and smooth muscle. After MP infects the body, it can produce autoantibodies of corresponding tissues, form immune complexes, and cause extrapulmonary manifestations of MP infection.

MP is a microorganism with no cell wall but only cell membrane, which is rich in protein. Therefore, erythromycin or azithromycin which can interfere with the synthesis of protein should be the first choice for sequential therapy. The blood concentration of the former is higher than that of the tissue. Rhodotorula should be the first choice for sequential treatment when clinical fever persists and children suspected of mycoplasma are diagnosed. After controlling mycoplasma, azithromycin can be used for intravenous drip or oral administration, which can not only control mycoplasma, but also reduce the toxicity of erythromycin to the liver. Compared with erythromycin, the concentration of azithromycin in tissue is 50 times that in blood, and its half-life is as long as 68 hours. The concentration of azithromycin in phagocytes and pathological tissues, especially lung tissues, is high and persistent, and the blood concentration can be maintained at a high level after 3 days of administration, with fewer adverse reactions than erythromycin. Azithromycin is the first choice for children without obvious mycoplasma pneumonia. If the body temperature continues to rise during the treatment, besides mycoplasma, we should also pay attention to whether there are bacterial infections, extrapulmonary complications and drug resistance. The combination of sensitive antibiotics and bacterial infection also takes symptomatic treatment for extrapulmonary complications.

At present, MP pneumonia is thought to be caused by MP itself and its immune response. Literature reports that inflammatory mediators in serum and bronchoalveolar lavage fluid of MP pneumonia patients increase, suggesting that MP pneumonia can have a strong inflammatory response, and adrenocortical hormone can inhibit immune inflammatory response. Therefore, hormone can be used for patients with severe illness, atelectasis, interstitial fibrosis, bronchiectasis or acute extrapulmonary complications. In this group, 2 children with brain injury and 5 children with pleural effusion were given 0. 1 ~ 0.25 mg/kg intravenous drip for 3 ~ 5 days after tuberculosis was eliminated, and there was no sequelae.

refer to

Dong Zongqi. Clinical manifestations of mycoplasma pneumoniae infection in children [J]. China Journal of Practical Pediatrics,1993,8 (3):199200.

Yu shanchang. Some problems about mycoplasma infection [J]. China Journal of Practical Pediatrics,1993,8 (3): 209.

, Pang, Jia Kunpeng. Extrapulmonary complications of mycoplasma pneumoniae infection 1 18 cases [J]. Journal of Applied Clinical Pediatrics, 2005,20 (4): 32021.

Zhuang Yuan, Dong Zongqi, Hu Yiji, et al. Some problems in the diagnosis and treatment of mycoplasma pneumoniae pneumonia in children [J]. China Journal of Practical Pediatrics, 2002, 17 (6): 449.

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